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Smart Benefits: 5 Healthcare Trend Predictions for 2013

Wednesday, December 05, 2012


The uncertainty of healthcare reforms dictated trends for 2012; what does the future hold for healthcare in 2013?

Last year’s uncertainty of healthcare reform’s future, the pending presidential election, and continued healthcare increases impacted 2012 trends. How? Insurance carriers launched new versions of HMOs, along with value-based plans; more employers offered wellness programs; and new purchasing arrangements for small businesses like Professional Employer Organizations (PEOs) grew in popularity. 

What about next year’s trends? Here are my five predictions.

1. Private Exchanges will Outpace Public Ones.

The federal government assumed that when offered the choice of setting up healthcare exchanges, or having the federal government establish them, most states would jump at the chance to take the control.  To the contrary, thirty states have said no. The problem? The federal government may not be prepared to take this task on, possibly delaying start-up January 1, 2014, of the public exchanges. In the meantime, private exchanges have been cropping up all around the country. Why? Private exchanges offer greater flexibility than their public counterparts:

  • Private exchanges might be offered by a single insurance carrier, a joining of multiple insurance carriers, or even third parties like benefit advisors or associations.

  • Private exchanges market to individuals, small businesses and even large employers, whereas most public exchanges will focus on the uninsured, individuals, and maybe small business, at least in the beginning.  

  • Private exchanges can offer a choice of plan designs and products like dental, vision, life, disability and voluntary, allowing employers to offer a new level of consumerism to employees, who can choose plans that fit their lifestyles and wallets.

With private exchanges first to market, they’ll have a competitive leg up over the public ones.

2. Innovation will Drive Benefit Plan Design.

Insurance carriers will continue to revamp their products. Since healthcare reform places emphasis on the physician-patient relationship, the carriers are meeting this demand with HMOs that require physician designation and referrals to specialists. Another growing option are plans that organize provider selection into tiers based on cost and efficiency. If consumers choose doctors in preferred tiers, they pay lower deductibles than seeking care from those in less preferred tiers. 

3. Limited Provider Networks Will Become the Norm.

All the carriers are readying to roll out limited provider networks for 2013, which shrink the number of providers by excluding some based on cost or quality to drive down premiums.  These plan designs are expected to become the norm so consumers will need to begin evaluating providers differently than in the past by leveraging tools and technologies that lead them to smarter decisions.

4. Consumer Engagement Will Increase.

Until now, there has been very little pricing transparency with providers – and little ability for consumers to do comparative shopping. That will all change. Insurance carriers are releasing powerful price estimators which allow consumers to shop services by setting (i.e. how much an MRI costs in a hospital setting versus a free standing facility), or how much the same prescription is at one pharmacy versus a competing retail chain.  And, all of these price comparison tools, along with other resources, are available through savvy new apps, compatible with most smart phones. 

5. Wellness Will Get Serious.

Employers who were hesitant to offer wellness programs are quickly  jumping on board. That’s because wellness makes sense: if you give employees activities, tools and resources, with meaningful incentives, they are more likely to modify lifestyles. The result? Healthier and happier employees, better morale and workplace satisfaction, and a slowdown of medical claims costs. To further drive engagement, insurance carriers and stand-alone wellness providers are adapting their programs to encourage team-based activities and gaming on smart phone, where most employees will focus their attention. They’re also making incentives more meaningful and personalized for employees.

While we continue to wait for healthcare reform to affect costs, my last prediction is that the best way to control them may be available in 2013.

Amy Gallagher has over 19 years of healthcare industry experience. As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.


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